Posted
by
samzenpuson Monday May 17, 2010 @02:29PM
from the sounds-like-rickets-to-me dept.

It's one of the fastest-growing health issues that doctors now face: "Google-itis." Everyone from concerned mothers to businessmen on their lunch break are typing in symptoms and coming up with rare diseases or just plain wrong information. Many doctors are bringing computers into examination rooms now so they can search along with patients to alleviate their fears. "I'm not looking for a relationship where the patient accepts my word as the gospel truth," says Dr. James Valek. "I just feel the Internet brings so much misinformation to the (exam) room that we have to fight through all that before we can get to the problem at hand."

In a world filled with perfect Doctors, I would agree with you. But in today's world of general practitioners who spend as little time with their patients as possible, individuals must take some amount of the research on to themselves.

My wife for example, is extremely flexible, to the point of being able to touch her fore-arm with her thumb on the same hand, dislocating joints, and other non-normal flexibility issues. She asked her doctor about it and got the basic "Is it causing you pain? No? Ignore it." But while researching another medical condition that she had been diagnosed with, she came across a reference to a genetic disease that causes this type of flexibility. She talked to her mother about it, 60 years old and still quite limber. She talked to her grandmother about it, 90 years old and she can still touch her toes with out bending her knees and join her hands behind her back (one over the shoulder, one under). It was pretty clear that the female side of her family was carrying this trait.

So next time she went to see her doctor, she mentioned the disease and the family history, the doc laughed and told her to leave the diagnosis to the "pros".

A month later when she was going to her new patient exam with her new general practitioner, she brought up the disease and family history. The doc listened, ordered some tests, and discovered that she did indeed have the disease. And it altered the treatment of her other condition.

So I'm just saying, even a good general practitioner won't be able to suss out all of your ailments if they are trying to diagnose you based on a 5 minute interview and what's in your chart. But if you point out some of the research you've done, even if they don't take you at your word, it can be enough to make them want to investigate that same avenue.

It's a good point. I've had a similar experience. I was told by my doctor that I had an incurable condition and would require expensive medication semi-regularly for the rest of my life. I immediately set out to learn more about the illness and upon doing further research I noted that some things didn't quite add up. I insisted on extra tests (just to be sure, doc) and sure enough they came back negative.

Now, a bit of internet reading won't make me an expert, but during my consultation it allowed me to be an active participant and not just a recipient of diagnosis from on high.

Now, a bit of internet reading won't make me an expert, but during my consultation it allowed me to be an active participant

Misdiagnosis is very common, rates around 10%-30% are often seen, so obviously a medical degree doesn't necessarily make one an expert either. Human disease is simply a far too varied field with far too many similar symptoms for doctors to have even a fighting chance to get it right much more than that with the time available for each patient.

It would be nice with more refined diagnosis tools on the net tho; easily accessible and structured decision trees which can guide you through how to both rule in and rule out possibilities would make a good tool for both patients and doctors. Done correctly it could even cut down unnecessary doctors visits and/or increase chances of early discovery of some diseases.

The NHS [wikipedia.org] has already produced a pretty good one [nhsdirect.nhs.uk]. They also have a really good selection of information on their NHS Direct site, and a local rate national helpline to talk about general health related issues. Slightly more geekily, they have a Behind the headlines [www.nhs.uk] news site which gives the real science behind some of the more heinously bad medical reporting that some sections of the media engage in.

I had a sore back and sore throat and went to the local 24hr clinic. They told me I pulled a muscle and that I had a lymph node infection. After taking the medication I broke out in a red polka-dot rash head-to-toe knowing full well I was not allergic to Amoxicillin (bleh spelling). So i booked an appointment with my doctor and he giggled after looking at my rash. Turns out I had mono and the "back pain" was my swollen appendix. The anti-infection medication caused the rash as it occurs when you have mono.

I am not a doctor. I am studying to be one. I talk to a lot of doctors. The patients who come in who have diagnosed themselves correctly, or close to correctly, such as getting the 'genus' of a disorder or disease correct while the 'species' is incorrect, are so rare that they tend to remember them.

Compare it to a Help Desk worker -- how many callers, per centum, do you think that Help Desk worker gets who would call up, have a correct or nearly so idea about what is wrong, and be calling only to get instructions on how to fix it?

When you are working with a small set of potential callers (i.e. in-house support, compared to, say, an ISP), you quickly start to know your "patients". You know the ones that call you every time a fart got blocked in their bowels and they want you to cure it (i.e. hold their hands, pet them, tell them to think of something pleasant...), the ones that call, have no idea but will do whatever you tell them, even if that includes making a handstand on their

i don't think you understand. doctors who pay due attention and give a shit are a rarity. while an untrained individual is not the best person to investigate and diagnose their ailments, at least you have someone paying attention to the issue. as a matter of fact, i think that if someone goes in and after 5 minutes takes what a doctor says on a serious medical issue to be the absolute truth, they are shamefully uninvolved in their personal wellness.

Which is kinda the whole point. Most doctors - general practitioner types see the same thing day in and day out. 999 times out of a 1000 basic symptoms have basic causes. So when that 1 in 1000 comes through it is entirely too easy to miss it. Thus it is really the patient's job to double-check the doctor's diagnosis, after all it is the patient with the most to lose. Any doctor which does not accept and even encourage the patient to get independent confirmation is a bad doctor. Maybe they get it from

IAAD, but an emergency physician so people generally don't have time to look stuff up. Or if they do, by definition, it's not an emergency. And the waiting room is in a Faraday cage, so their iphones don't work either, a very satisfactory arrangement.

When I talk to my GP (family physician) colleagues about this, they say you have to work with it, and this phenomenon always occurred to a certain extent, it's just that in the old days the nutters had to go to the medical libraries, and so were easier to identify. Nowadays, quite rational people look up their symptoms and get things right, and this is good.

There are real medical problems with the internet and increased accessibility of information, but far more than increasing anxiety, I would say worse problems are:

aggressive libel laws stifling scientific debate [guardian.co.uk] which in the old days would have been shielded from lawyers.

looneys can find each other and associate more easily, and act aggressively to those who do not share their very strange view of the world - e.g. 'Myalgic Encephalitis sufferers' (an alleged condition that is neither myalgic or encephalitis and it is everyone else who does the suffering).

Patients usually give you a clue that they are a looney though, which is very helpful. Favoured tell-tale signs are wearing tinted glasses, a soft neck collar or making notes in purple ink or with RANDOM capitalised words, or using one of those obesity scooter things. But if they seem relatively normal, I listen carefully and explain, because quite often they are right.

BTW, I presume you were referring to this [wikipedia.org]? Although some other conditions can do this as well.

Just wondering if said condition is Marfan Syndrome, or the semi-related connective tissue disorders (CTD) of [certain types of] EDS, or Loews-Dietz Syndrome.

My wife is on the board of directors of the National Marfan Foundation [marfan.org] (which also addresses related CTD's), and runs a chapter in California. If you like, I am sure that she could hook you up with excellent doctors, medical advice, and/or network groups, if you so desire. Also, there is an annual nationwide conference coming up in Houston from Ju

I used to have H. Ross Perot coming into my house and showing me pie charts on outsourcing. You're right, it's very painful.

Oh, wait. You're talking about some other EDS.

Yeah, and the disease changes over time. When I was there the symptoms of EDS* were depression, loss of appetite, unwillingness to wake up in the morning, disrupted sleep schedules, deep-seated hatred of people in power, and sudden joblessness after making an expensive insurance claim.

* Also known as "Brown, Dick syndrome" due to how the CEO's name appeared in your inbox on his regular self-congratulatory newsletters to everyone in the company with an @eds.com e-mail address.

Yeah, there will always be hypochondriacs. However, in the past, patients used to blindly trust their doctors. These days, doctors have to convince their patients that they have made a correct diagnosis. I don't necessarily see this as a bad thing.

I think every website that lists all these varied diseases should put a rarity score next to each illness. That way when you think you've got Wilson's disease, you can look and see with a simple number how unlikely it is.

Nice idea, but it probably wouldn't work very well. One, people are notoriously bad at estimating risk. Two, if you really think you have the symptoms that fit a particular disease, you'll just assume that "yes I really am that one person in 2.5 million that has this disease". Three, if one in a 100,000 is a "high-risk disease", because very few conditions have higher rates, it'll make it easier to convince yourself that you have it. Four, there is no fourth point.

Along with that, due to people's natural inflation of their own importance, even if they see 1 in 2.5 million, they won't consider how very small that number is because THEY are more important than the other 2.5 million people who won't get this disease.

I think every website that lists all these varied diseases should put a rarity score next to each illness.

I'd want such scores for the opposite reason. My doctor Googles everything I tell him about, and concludes I never have anything. He doesn't "suffer from" his patient's Googling. That's how he practices medicine!

Polls also show that everybody thinks they one of the top 10% of drivers that are the best, safest, and most experienced behind the wheel. People - at least 93% of them - are just about always wrong about anything involving statistics.

Yes to this and to the GP, but it depends a lot on the doctor. My former doctor really didn't listen to me at all, and tended to brush off any symptoms I brought to him (the only reason I ended up getting the knee surgery I desperately needed was that he felt, as a GP, that he wasn't completely qualified to evaluate joints. His exact words were "it's probably nothing, but I'll give you a referral to an orthopedic surgeon just in case."). My current doctor, on the other hand (and a big part of the reason

Well the medical dramas in general. Yesterday I was seeing something on TV how the Crime shows make the world seem more violent then it actually is. I am sure the same thing about these medical shows. In real life House wouldn't be getting a Random Patient once a week, that he finds worthy of his diagnosis. That would probably happen once a year. In the meantime he would probably be visiting people who have been referred to by other doctors who are stumped, in less of an emergency situation but in a we

I'll start. My wife had intense abdominal pains which her GP diagnosed as an intestinal blockage, and prescribed liquids, laxatives, and rest.

When she didn't get better, she "Googled" her symptoms, and found that the birth control Yaz had been linked to gallbladder issues, which fit the symptoms. She told her GP -- who had never heard of these side effects -- and had her liver enzymes checked. Sure enough, they were below average. My wife was scheduled for a ($20k) liver function test, and simultaneously taken off Yaz. The symptoms subsequently disappeared, enzyme levels returned to normal, and she opted not to get the test.

Now this may well be a coincidence, as I myself have pointed out, but if it wasn't, it's a clear case where Google-itis saved us 20 grand, since she never would have had the idea to stop taking Yaz if she hadn't found similar cases online.

The dirty truth that's seldom told is: Your doctor doesn't know any better than you do. He or she is making highly educated guesses, and that's about the end of it.

Your tribal witchdoctor of years past had less knowledge, but was doing the exact same thing. Science came along and made medicine less of a guessing game, but it can never remove it completely.

From TFA:

No longer is it between a doctor who knows all and a parent who knows nothing.

Show me the doctor who genuinely 'knows all' and I'll show you a miracle worker. It simply doesn't work that way, never has, and I'm sorry if it makes some practitioners sad that the patients have more tools.

As in the case above, however, this is genuinely a good thing for us all.

"Guessing"? To say that medical practitioners, as a whole, are "guessing" is incredibly naive. Does the bridge engineer guess on the load bearing capacity? Does the auto mechanic guess what the appropriate timing is on your timing belt? What about an airline pilot navigating from one airport to another and landing safely? No, no, and no. They use KNOWLEDGE, EXPERIENCE, TOOLS, and INTUITION.

Likening these traits to a medical professional:

KNOWLEDGE: medical school, journals, CME

EXPERIENCE: rotations and/or residencies, practicing professionally

TOOLS: blood tests, ECG, CT, symptoms

INTUITION. The final one is gleaned through common sense, logic, knowledge, experience and tools.

Guessing? While there may be those at the lower end of the spectrum that may lack in some of these areas, to generalize so is unfair and misinformed.

Not sure that's a counter, actually; I don't think that's the kind of behavior doctors are concerned about. When your wife found the evidence that she may have been misdiagnosed, she went to her doctor to confirm it and get his opinion; she didn't dismiss him as a quack and go all homeopathic on him, or assume that he was an idiot and stop taking his advice seriously.

That is so wise. Your doctor is, in the end, a tool you use in your own attempt to stay alive and healthy. Understanding doctors and how to use them is crucial. I mostly get great care from Doctors, because I ask them questions in their specialisation; try to be informed in advance. Assume that the doctor does have valid experience and knowledge. Do not assume that the doctor can do statistics (well over 90% of Doctors fail basic tests at explaining statistics in their own field!!!). Do ask questions,

Of course it's the behavior that doctors are concerned about. Their entire professional skill of diagnosing medical problems can be handed over to an automated game of twenty questions.

Now, we still need them to look at x-rays, make judgment calls on treatments, and a large list of other things that doctors get trained in, but 95% of diagnoses should be automated. It would have a better hit-rate then doctors, and cost a hell of a lot less then the doctor's rate. And don't hand me that bullshit about insur

I've been less than impressed with the overall abilities of the 'GP' doctors I've been to. If you need a common prescription or a sports physical - sure. Beyond that, in my experience, you might as well just ask a nurse. You'll get the same answer.

I had a sore wrist. Went to a GP and he told me not to do pushups and that when I get out of a chair I should hold my wrist like this, and not like that. I looked at him like he was crazy.

I went online, did some research, and concluded that I *most likely* ha

True story - I woke up one morning and my eyes were both full of floating debris and this circular ring. Also there were lots of flashes in my eye. None of this is a good sign so I googled the symptoms and it said I likely had a detached retina and I should go to hospital immediately. I did, and yes, both retinas had significant rips and needed multiple laser treatments, a couple of vitrectomies and a membranectomy before I was given the all clear. The morning I presented the doctor told me that it was very good that I had come in so quickly because it could quickly have deteriorated to a stage where it wouldn't have been repairable.

Of course, my symptoms were pretty obvious and I had an idea what it was before I even started looking but the first hit said 'go to hospital. Now'. Very good advice. I wonder how often the opposite is true and people use Google and find that it suggests it is nothing to worry about and they don't go to the doctor? My guess is that is rather rare compared with the hypochondriacs who have nothing wrong with them.

As you age, the vitreous (the jelly part in the eye) starts to liquify. This is normal and it starts around the edges where it connects with the retina and pretty much everyone goes through this. Normally you'll see a rise in floaters in your eye as early as your 40's and it is associated with being short sighted. Sometimes, as the vitreous liquifies, some parts are still attached to the retina and this tugs at the surface and can pull sections away and that is what happened to me in both eyes (Posterior

I came down with the flu, I checked WebMD, it said not to bother going in to doctor unless the symptoms persisted or I became dehydrated. So yes, at least one person has followed the instructions not to go to the doctor.

I wonder how often the opposite is true and people use Google and find that it suggests it is nothing to worry about and they don't go to the doctor?

Well, I was playing with my little daughter and suddenly her elbow was in terrible pain. I googled it and decided it was probably Nursemaid's Elbow [uchicago.edu]. I did the suggested treatment (turning her palm up and flexing her elbow) and the ligament snapped back into place, and she was immediately better. A trip to the doctor or hospital would likely have taken the

A buddy of mine had severe sinus congestion. His doctor told him to take Afrin. [wikipedia.org] Over the course of several years, his sinus congestion became worse. His doctor performed all sorts of exotic therapies, [wikipedia.org] and continued to recommend Afrin. Thanks to Google, and Wikipedia, he discovered that long term use of Afrin can cause a dependency, and actually make the symptoms worse. [wikipedia.org] A second opinion by another doctor confirmed his internet diagnosis, and he is doing much better.

..one person actually cares about the patients health. Is it the one who made an appointment to go through an uncomfortable examination because they felt like something was wrong, or the one trying to squeeze as many credit ca... people through his business in an hour as possible?

Do your own research people. Go to your doctor armed with information, and don't let them brush off your concerns. Will your doctor like it? No, he went to medical school, and who are you to think you'd know something about your

Family doctors are pretty much useless. Why do I need to book for an appointment, wait like 30-40mins at the clinic even though I have an appointment, and only able to talk to the doctor for 5mins?

I went to do my annual check-up with the family doctor a year ago, and I complained to him about my day-time sleepiness. The doctor simply dismissed it as "bored at work". I basically had to google the symptom myself afterward to discover that I might have sleep-apnea, and then book another appointment to tell the family doctor to just give me a referral to see a sleep specialist to do more comprehensive test. Lord and behold, my self-diagnose was confirmed by the sleep lab, and I even knew that the treatment would be CPAP before the sleep doctor suggested it.

The point of the story is, yes, there will be paranoid people who suspect they are dying of rare diseases because of their headache and whine to their doctor all day. For most people, they are better off googling their own symptom first, get a general understanding of what could be the cause of it, so that you can better talk to your family doctor on what test to do and which specialist to see.

Hey, you don't go to see a car salesman before doing your homework, why go see your doctor without getting a better idea of your own health?

Turned out to be bursitis. To be fair, I didn't really google it but went to webmd so I didn't end up in hypochondriac hell. It was very specific about every symptom I had (swollen elbow, the sort of pain, the warmness), and it gave me a reasonable diagnosis (don't mess with it, use the body part as little as possible, see a doctor if it doesn't stop being swollen in about two weeks). It saved me a doctor's visit, but more importantly, it gave me peace of mind.

I'm very well aware that sites like those, particularly online versions of the DSM IV, are hellholes for developing hypochondriacs, but when used responsibly with reasonable expectations, sites that are more professional in tone can be very useful. And if you don't like what you read, or it gets worse, well, you get to make the call about going to the doctor instead.

this is medical medicine...its complex, dangerous quackery not well suited for the average person...you need years of institutionalization before attempting it, and google will usually just suggest crazy things like a healthy diet and exercise...this is counterproductive to your well-being as it distracts you from your television.

We, the medical community, have contracted ineffably large pharmaceutical conglomerates and enlisted their superior knowledge of your symptoms in order to diagnose and treat man

This happens everywhere. No one wants to work the problem. They want to provide a solution and complain when you don't implement it. We see this in software all the time. So client comes in and says 'I want t a web site that looks like this and has these pages.' As responsible professionals we ask 'what is it you are trying to do', not to pad billable hours or because we don't want to do the work, but because we know that to often the client has been told the solution, independent of whether it is a re

2 months after finishing college and starting a new job in a new area, I woke up one morning with an odd stomach pain. I didn't think anything of it, so I went to work. By lunch time, the pain did not relax at all. It didn't get worse... just a steady piercing pain. I told a co-worker I was taking a half day. By 5pm, I was starting to get really worried because this was not a normal feeling stomach pain, and it was still there.

Ok, I don't have any hard data, but it seems to me that in reality today for every patient with mis-informed "Googleitis" there are ten or more people who are getting better medical care because they are informed about their condition or even have already correctly self-diagnosed. Some of the comments right here to point.

But doctors are upset because they are not used to having informed patients. They are used being the godlike arbitors of secret knowledge whose judgement will be trusted 100% because of their degree. But in reality of course they are human and all too fallible, and even more so nowadays that they are increasingly simply pharmaceutical salesmen rather than healers and don't really have or take the time to actually know their patients.

Before doctors found it easy to be confident... because hardly anyone ever questioned them. Now things are getting a bit more difficult. Poor doctors? I'm finding it difficult to be sympathetic.

There may be a lot of information of questionable quality on the Net, but overall I have not a shred of doubt that the empowerment the Net has brought to the individual in this regard has been a boon to public health.

Your health, your responsibility. Period. Many doctors can be dismissive, usually with good cause, that is their experience. However even good doctors can be surprised. None are suspecting that rare condition. The only way they will test for it is if you are insistent. Some not even then, in which case you shouldn't be afraid to see a new doctor. The internet is a powerful tool, and can be very useful for a savvy user. One just has to be aware that not all sites are reputable or of the same quality. Also there is a lot of things out there, and to not get worked up about what could be wrong with you and looking at worst case scenarios. Finally, your not a doctor, so using your own judgement and what you can glean from the internet, go see a doctor is you feel the need to. True story: I felt I was having trouble breathing and chest pain. This was dismissed as stress (I was young 30). However having read too much about worse case, quickly turned into panic attacks and anxiety making it worse in a sort of feedback loop. Anyway I figured it out, but it wasn't fun. During this time I remember talking to a friend of mine who gave me the speech about being your own health advocate, and being responsible for your health not a doctor. When she was younger (early 20's) she was dismissed by many doctors, but through persistence was diagnosed with cancer. Which she beat. However had she not been as persistant things might have been different. She was young, and healthy, and it was a rare diagnoses, but it happens.

So I guess what I am trying to say is that:1) Ultimately your health is your own responsibility using the internet to help you is a good idea,2) However temper your imagination, and try not to get worked up about possible outcomes.

There will always be hyperchondriacs and there always were. Technology isn't changing any of that.

I disagree somewhat. While I doubt technology/Google makes non-hypochondriacs into hypochondriacs, I do think it makes the existing ones worse. The last thing such a person needs is a seemingly definitive diagnosis of the worst thing that could be wrong with them. ("Oh no! A woman with AIDS reported having a rash on her legs. I have a rash. Oh my god!!! I have AIDS!")

And here I thought syllogistic reasoning was so obvious it didn't need to be taught...

Damnit people; please read the fine comments before responding. The hyperchondriacs are just so convinced that they don't have the disease, they'll never even open their computer, let alone Google it. Just getting them to the doctor in the first place would be a good start.

So here's one for you: Why can't you fight that misinformation before the patient even steps foot in the exam room? Why don't doctors create peer-reviewed, well-written websites to counter all of the confusion and pseudo-science currently available online?

Because then the Dr. is liable for any information that he may have "pointed" you towards. Even peer-reviewed information, while it may cover the majority of the seekers' symptoms more accurately than the pseudo-science, there's that small percentage that

I personally am interested in pharmaceuticals and discovered that contrary to the line of bull big pharma gives us, hard powder pills do NOT drop in potency even 10 years later when stored properly. your old perkadan and Darvoset pills from 10 years ago are still highly potent. and generic low strength Anti-biotics are just as effective years later.

How did I test? the same way they do. Pitri dishes with a growth medium and a incuba

As much as I tend to encourage people to do a bit of science on the side, I have to make a couple of remarks on this, being a biochemist myself. First - your conclusion is wrong. You at best showed that penicillin stays active when stored in dry powdered form. Drawing conclusions to any arbitrary substance is a bit far-fetched. That is a very important thing that you have to learn when doing science properly - how to assess what conclusions you can actually draw from your data.

Second - what where the concentrations you used? If you applied the penicillin at significant "overkill" concentration, you would basically see the statistical average amount of resistant cultures left in both cases. To be sure, you gotta do the experiment at different concentrations, and you gotta duplicate the plates for the experiment and the control, so you can compare the patterns of kill-off.

Third, even if you showed that the potency stays roughly the same, you did not show if there are degradation products which could possibly be harmful for a patient - you would need to do a toxicity assay to be sure that it stays harmless for the patient.

Forth, regarding the remaining colonies - did they survive because of innate resistance or because the antibiotic concentration was too low?

Generally I think your conclusion is probably right, but the data you showed are not sufficient to make that conclusion. What you did is great for a college-level experiment, but in reality, there are more factors that you have to check for. That's why I sunk a couple of years of my life into studying that stuff. As I said, this is not to discourage you - doing science at home is great fun and you can learn a lot, but you gotta be careful evaluating your data. The most important part about science is, at least to me, that you gotta be aware that a single experiment might answer one question, but raises 10 others, on which you gotta follow up.

...if Medicine wasn't such a members-only club. There's the "In" crowd and then there's the "Rest" of us.

Take other fields.... writing, education, programming, painting, online stock trading -- anyone can hop online or go down to their local bookstore,

I'm a doctor.You mean a multi-billion investment fund will take my advice where to invest their clients' money? I should just email them after having read some books?

Or perhaps the city will let me design a bridge? Or maybe I could learn to fly on Microsoft Flight Simulator and give my airline pilot advice during the next turbulent flight I encounter?Maybe I should barge in and tell the magistrate in court what they should do - I've seen Perry Mason do it and read some books.

"I just feel the Internet brings so much misinformation to the (exam) room that we have to fight through all that before we can get to the problem at hand."

Take other fields.... writing, education, programming, painting, online stock trading -- anyone can hop online or go down to their local bookstore, get How-To books, and start to do actual work in hundreds of different fields.

It's interesting that you mention programming because video game programming is another field with entry barriers. You have to do a "residency" of sorts by releasing a successful title for PC before you're allowed to develop console games.

Why don't doctors create peer-reviewed, well-written websites to counter all of the confusion and pseudo-science currently available online?

But just because there are some good reasons, some of the time, to lock up some medical knowledge or access to the tools of the trade, doesn't mean that there won't be hundreds if not thousands of motivated individuals that want to try to tackle their own medical problems the same way they do home improvement projects.

Erm, what?

Medical knowledge is not locked up. Nobody is stopping you from buying the exact same textbooks as the doctors. Nobody is stopping you from knowing pretty much everything a docto